Rural youth are at greater risk for using tobacco and less likely to have access to tobacco intervention than are their non-rural counterparts. This presents an important public health challenge. One innovative response is to use the emergency department (ED) as a point of access for delivering brief tobacco interventions to rural teens. The ED is an appropriate point of access because it provides a safety net for those who may otherwise go unserved. In addition, it is a frequent source of "front-line" health care services among rural, low SES (populations where smoking prevalence is high. The primary goal of this project is to examine the feasibility and efficacy of a theory-based motivational tobacco intervention (MTI) for 14- to 18-year-old smokers who present in the West Virginia University (WVU) Hospital ED for treatment. To examine feasibility, a comprehensive model (i.e., CIPP) found useful for evaluating other clinical programs and services will be used to assess reach, implementation fidelity, and acceptability. To examine efficacy, a randomized 2-group design will be used to compare the 6-month post-baseline quit and reduction rates among youth who receive MTI to those who receive brief advice/care as usual (BA). MTI patients will receive (1) screening/assessment and a brief, tailored, motivational interview, (2) a tailored self-help workbook (with audio), and (3) 3 follow-up telephone contacts. BA patients will receive less than or equal to 2 minutes of generic advice to quit smoking and a "1-800" referral number to WVU Hospital's general health information help line. Smoking abstinence will be determined by self-report with biochemical validation (expired air carbon monoxide of less than 9ppm). Reduction will be determined by decreases in daily cigarette use between baseline and follow up. This project is intended to generate research findings that inform practice in a modest time frame. Therefore, following demonstration of feasibility and efficacy, a secondary goal of the project is to develop a transportable MTI package, including materials and practice recommendations for EDs, to guide future study and dissemination of MTI.